Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes
Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. M...
Ausführliche Beschreibung
Autor*in: |
Orcutt, Sonia T. [verfasserIn] Massarweh, Nader N. [verfasserIn] Li, Linda T. [verfasserIn] Artinyan, Avo [verfasserIn] Richardson, Peter A. [verfasserIn] Albo, Daniel [verfasserIn] Anaya, Daniel A. [verfasserIn] |
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E-Artikel |
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Sprache: |
Englisch |
Erschienen: |
2016 |
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Schlagwörter: |
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Übergeordnetes Werk: |
Enthalten in: Annals of surgical oncology - Berlin [u.a.] : Springer, 1994, 24(2016), 1 vom: 24. Juni, Seite 23-30 |
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Übergeordnetes Werk: |
volume:24 ; year:2016 ; number:1 ; day:24 ; month:06 ; pages:23-30 |
Links: |
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DOI / URN: |
10.1245/s10434-016-5351-8 |
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Katalog-ID: |
SPR009983155 |
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520 | |a Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65–75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39–1.97; >75 years: OR 3.84, 95 % CI 3.13–4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16–1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). Conclusions The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. Future initiatives should focus on increasing treatment among older patients as well as on evaluating reasons leading to the no-treatment approach and increased use of ablation procedures. | ||
650 | 4 | |a Veteran Affair |7 (dpeaa)DE-He213 | |
650 | 4 | |a Colorectal Liver Metastasis |7 (dpeaa)DE-He213 | |
650 | 4 | |a Trend Test |7 (dpeaa)DE-He213 | |
650 | 4 | |a Ablative Therapy |7 (dpeaa)DE-He213 | |
650 | 4 | |a Current Procedural Terminology |7 (dpeaa)DE-He213 | |
700 | 1 | |a Massarweh, Nader N. |e verfasserin |4 aut | |
700 | 1 | |a Li, Linda T. |e verfasserin |4 aut | |
700 | 1 | |a Artinyan, Avo |e verfasserin |4 aut | |
700 | 1 | |a Richardson, Peter A. |e verfasserin |4 aut | |
700 | 1 | |a Albo, Daniel |e verfasserin |4 aut | |
700 | 1 | |a Anaya, Daniel A. |e verfasserin |4 aut | |
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2016 |
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10.1245/s10434-016-5351-8 doi (DE-627)SPR009983155 (SPR)s10434-016-5351-8-e DE-627 ger DE-627 rakwb eng 610 ASE 44.81 bkl 44.65 bkl Orcutt, Sonia T. verfasserin aut Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65–75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39–1.97; >75 years: OR 3.84, 95 % CI 3.13–4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16–1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). Conclusions The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. Future initiatives should focus on increasing treatment among older patients as well as on evaluating reasons leading to the no-treatment approach and increased use of ablation procedures. Veteran Affair (dpeaa)DE-He213 Colorectal Liver Metastasis (dpeaa)DE-He213 Trend Test (dpeaa)DE-He213 Ablative Therapy (dpeaa)DE-He213 Current Procedural Terminology (dpeaa)DE-He213 Massarweh, Nader N. verfasserin aut Li, Linda T. verfasserin aut Artinyan, Avo verfasserin aut Richardson, Peter A. verfasserin aut Albo, Daniel verfasserin aut Anaya, Daniel A. verfasserin aut Enthalten in Annals of surgical oncology Berlin [u.a.] : Springer, 1994 24(2016), 1 vom: 24. Juni, Seite 23-30 (DE-627)343969947 (DE-600)2074021-9 1534-4681 nnns volume:24 year:2016 number:1 day:24 month:06 pages:23-30 https://dx.doi.org/10.1245/s10434-016-5351-8 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2070 GBV_ILN_2086 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2116 GBV_ILN_2118 GBV_ILN_2119 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.81 ASE 44.65 ASE AR 24 2016 1 24 06 23-30 |
spelling |
10.1245/s10434-016-5351-8 doi (DE-627)SPR009983155 (SPR)s10434-016-5351-8-e DE-627 ger DE-627 rakwb eng 610 ASE 44.81 bkl 44.65 bkl Orcutt, Sonia T. verfasserin aut Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65–75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39–1.97; >75 years: OR 3.84, 95 % CI 3.13–4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16–1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). Conclusions The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. Future initiatives should focus on increasing treatment among older patients as well as on evaluating reasons leading to the no-treatment approach and increased use of ablation procedures. Veteran Affair (dpeaa)DE-He213 Colorectal Liver Metastasis (dpeaa)DE-He213 Trend Test (dpeaa)DE-He213 Ablative Therapy (dpeaa)DE-He213 Current Procedural Terminology (dpeaa)DE-He213 Massarweh, Nader N. verfasserin aut Li, Linda T. verfasserin aut Artinyan, Avo verfasserin aut Richardson, Peter A. verfasserin aut Albo, Daniel verfasserin aut Anaya, Daniel A. verfasserin aut Enthalten in Annals of surgical oncology Berlin [u.a.] : Springer, 1994 24(2016), 1 vom: 24. Juni, Seite 23-30 (DE-627)343969947 (DE-600)2074021-9 1534-4681 nnns volume:24 year:2016 number:1 day:24 month:06 pages:23-30 https://dx.doi.org/10.1245/s10434-016-5351-8 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2070 GBV_ILN_2086 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2116 GBV_ILN_2118 GBV_ILN_2119 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.81 ASE 44.65 ASE AR 24 2016 1 24 06 23-30 |
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10.1245/s10434-016-5351-8 doi (DE-627)SPR009983155 (SPR)s10434-016-5351-8-e DE-627 ger DE-627 rakwb eng 610 ASE 44.81 bkl 44.65 bkl Orcutt, Sonia T. verfasserin aut Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65–75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39–1.97; >75 years: OR 3.84, 95 % CI 3.13–4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16–1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). Conclusions The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. Future initiatives should focus on increasing treatment among older patients as well as on evaluating reasons leading to the no-treatment approach and increased use of ablation procedures. Veteran Affair (dpeaa)DE-He213 Colorectal Liver Metastasis (dpeaa)DE-He213 Trend Test (dpeaa)DE-He213 Ablative Therapy (dpeaa)DE-He213 Current Procedural Terminology (dpeaa)DE-He213 Massarweh, Nader N. verfasserin aut Li, Linda T. verfasserin aut Artinyan, Avo verfasserin aut Richardson, Peter A. verfasserin aut Albo, Daniel verfasserin aut Anaya, Daniel A. verfasserin aut Enthalten in Annals of surgical oncology Berlin [u.a.] : Springer, 1994 24(2016), 1 vom: 24. Juni, Seite 23-30 (DE-627)343969947 (DE-600)2074021-9 1534-4681 nnns volume:24 year:2016 number:1 day:24 month:06 pages:23-30 https://dx.doi.org/10.1245/s10434-016-5351-8 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2070 GBV_ILN_2086 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2116 GBV_ILN_2118 GBV_ILN_2119 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.81 ASE 44.65 ASE AR 24 2016 1 24 06 23-30 |
allfieldsGer |
10.1245/s10434-016-5351-8 doi (DE-627)SPR009983155 (SPR)s10434-016-5351-8-e DE-627 ger DE-627 rakwb eng 610 ASE 44.81 bkl 44.65 bkl Orcutt, Sonia T. verfasserin aut Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65–75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39–1.97; >75 years: OR 3.84, 95 % CI 3.13–4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16–1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). Conclusions The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. Future initiatives should focus on increasing treatment among older patients as well as on evaluating reasons leading to the no-treatment approach and increased use of ablation procedures. Veteran Affair (dpeaa)DE-He213 Colorectal Liver Metastasis (dpeaa)DE-He213 Trend Test (dpeaa)DE-He213 Ablative Therapy (dpeaa)DE-He213 Current Procedural Terminology (dpeaa)DE-He213 Massarweh, Nader N. verfasserin aut Li, Linda T. verfasserin aut Artinyan, Avo verfasserin aut Richardson, Peter A. verfasserin aut Albo, Daniel verfasserin aut Anaya, Daniel A. verfasserin aut Enthalten in Annals of surgical oncology Berlin [u.a.] : Springer, 1994 24(2016), 1 vom: 24. Juni, Seite 23-30 (DE-627)343969947 (DE-600)2074021-9 1534-4681 nnns volume:24 year:2016 number:1 day:24 month:06 pages:23-30 https://dx.doi.org/10.1245/s10434-016-5351-8 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2070 GBV_ILN_2086 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2116 GBV_ILN_2118 GBV_ILN_2119 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.81 ASE 44.65 ASE AR 24 2016 1 24 06 23-30 |
allfieldsSound |
10.1245/s10434-016-5351-8 doi (DE-627)SPR009983155 (SPR)s10434-016-5351-8-e DE-627 ger DE-627 rakwb eng 610 ASE 44.81 bkl 44.65 bkl Orcutt, Sonia T. verfasserin aut Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65–75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39–1.97; >75 years: OR 3.84, 95 % CI 3.13–4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16–1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). Conclusions The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. Future initiatives should focus on increasing treatment among older patients as well as on evaluating reasons leading to the no-treatment approach and increased use of ablation procedures. Veteran Affair (dpeaa)DE-He213 Colorectal Liver Metastasis (dpeaa)DE-He213 Trend Test (dpeaa)DE-He213 Ablative Therapy (dpeaa)DE-He213 Current Procedural Terminology (dpeaa)DE-He213 Massarweh, Nader N. verfasserin aut Li, Linda T. verfasserin aut Artinyan, Avo verfasserin aut Richardson, Peter A. verfasserin aut Albo, Daniel verfasserin aut Anaya, Daniel A. verfasserin aut Enthalten in Annals of surgical oncology Berlin [u.a.] : Springer, 1994 24(2016), 1 vom: 24. Juni, Seite 23-30 (DE-627)343969947 (DE-600)2074021-9 1534-4681 nnns volume:24 year:2016 number:1 day:24 month:06 pages:23-30 https://dx.doi.org/10.1245/s10434-016-5351-8 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2070 GBV_ILN_2086 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2116 GBV_ILN_2118 GBV_ILN_2119 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.81 ASE 44.65 ASE AR 24 2016 1 24 06 23-30 |
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English |
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Enthalten in Annals of surgical oncology 24(2016), 1 vom: 24. Juni, Seite 23-30 volume:24 year:2016 number:1 day:24 month:06 pages:23-30 |
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Veteran Affair Colorectal Liver Metastasis Trend Test Ablative Therapy Current Procedural Terminology |
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Orcutt, Sonia T. @@aut@@ Massarweh, Nader N. @@aut@@ Li, Linda T. @@aut@@ Artinyan, Avo @@aut@@ Richardson, Peter A. @@aut@@ Albo, Daniel @@aut@@ Anaya, Daniel A. @@aut@@ |
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We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65–75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39–1.97; >75 years: OR 3.84, 95 % CI 3.13–4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16–1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). Conclusions The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. 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Orcutt, Sonia T. |
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Orcutt, Sonia T. ddc 610 bkl 44.81 bkl 44.65 misc Veteran Affair misc Colorectal Liver Metastasis misc Trend Test misc Ablative Therapy misc Current Procedural Terminology Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes |
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610 ASE 44.81 bkl 44.65 bkl Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes Veteran Affair (dpeaa)DE-He213 Colorectal Liver Metastasis (dpeaa)DE-He213 Trend Test (dpeaa)DE-He213 Ablative Therapy (dpeaa)DE-He213 Current Procedural Terminology (dpeaa)DE-He213 |
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ddc 610 bkl 44.81 bkl 44.65 misc Veteran Affair misc Colorectal Liver Metastasis misc Trend Test misc Ablative Therapy misc Current Procedural Terminology |
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ddc 610 bkl 44.81 bkl 44.65 misc Veteran Affair misc Colorectal Liver Metastasis misc Trend Test misc Ablative Therapy misc Current Procedural Terminology |
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Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes |
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Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes |
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Orcutt, Sonia T. |
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Orcutt, Sonia T. Massarweh, Nader N. Li, Linda T. Artinyan, Avo Richardson, Peter A. Albo, Daniel Anaya, Daniel A. |
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Orcutt, Sonia T. |
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patterns of care for colorectal liver metastasis within an integrated health system: secular trends and outcomes |
title_auth |
Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes |
abstract |
Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65–75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39–1.97; >75 years: OR 3.84, 95 % CI 3.13–4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16–1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). Conclusions The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. Future initiatives should focus on increasing treatment among older patients as well as on evaluating reasons leading to the no-treatment approach and increased use of ablation procedures. |
abstractGer |
Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65–75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39–1.97; >75 years: OR 3.84, 95 % CI 3.13–4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16–1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). Conclusions The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. Future initiatives should focus on increasing treatment among older patients as well as on evaluating reasons leading to the no-treatment approach and increased use of ablation procedures. |
abstract_unstemmed |
Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65–75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39–1.97; >75 years: OR 3.84, 95 % CI 3.13–4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16–1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). Conclusions The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. Future initiatives should focus on increasing treatment among older patients as well as on evaluating reasons leading to the no-treatment approach and increased use of ablation procedures. |
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Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes |
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Massarweh, Nader N. Li, Linda T. Artinyan, Avo Richardson, Peter A. Albo, Daniel Anaya, Daniel A. |
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score |
7.3989916 |